Interpersonal Psychotherapy for Women With Comorbid Depression and Chronic Pain
Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY 14642, USA. email@example.comThe Journal of nervous and mental disease (Impact Factor: 1.69). 08/2010; 198(8):597-600. DOI: 10.1097/NMD.0b013e3181ea4d3d
Chronic pain is prevalent among patients with depression and a risk factor for poor depression treatment outcomes. No known psychotherapy approaches have been developed to target the needs of patients with comorbid depression and chronic pain. This study's goals were to evaluate feasibility, acceptability, and initial effects of interpersonal psychotherapy adapted for women with depression and chronic pain. Seventeen women with major depression and chronic pelvic pain were offered 8 sessions of individual treatment, interpersonal psychotherapy for depression and pain (IPT-P). Participants were recruited from a women's health clinic, were predominantly low-income and minority, and generally did not initially self-identify as depressed. Large effect sizes with significant improvements were found for depression severity and social adjustment; pain interference remained unchanged. Most enrolled patients reported a high level of satisfaction with IPT-P. This pilot study provides preliminary support for the use of IPT-P for patients with comorbid depression and chronic pain.
- [Show abstract] [Hide abstract]
ABSTRACT: GPR3 is an orphan G-protein coupled receptor broadly expressed in brain structures controlling emotional-like behaviors and pain. GPR3 receptor up-regulates cAMP and promotes neurite outgrowth in mammalian neurons, being a good candidate to participate in the pathophysiology of neurodegenerative diseases as well as brain and spinal cord injuries. In this study, we evaluated the role of GPR3 receptor in the development and expression of neuropathic pain after sciatic nerve ligature, and the inflammatory reaction in the dorsal horn of the spinal cord in both Gpr3-/- and Gpr3+/+ mice. Hyperalgesia to noxious thermal stimulus and allodynia to cold and mechanical stimuli were evaluated using the plantar test, the cold-plate test and the Von Frey filament model, respectively. Additionally, we evaluated the involvement of GPR3 receptors in morphine-induced antinociception using the tail immersion test. After nerve injury, Gpr3-/- mice showed a higher sensitivity to thermal non-noxious and noxious stimuli than Gpr3+/+ mice, whereas no differences were observed between genotypes in mechanical allodynia. In addition, no differences in microglia and astrocytes activation were found when compared the ipsilateral dorsal horn of Gpr3-/- and Gpr3+/+ mice exposed to nerve ligature. On the other hand, the genetic deletion of GPR3 receptors reduced morphine antinociception in the tail immersion test in mice without any changes in basal thermal threshold. Taken together, our results demonstrate, for the first time, the involvement of the orphan GPR3 receptor in the expression and development of neuropathic pain and in the analgesia induced by morphine. The lack of GPR3 receptors produced hypersensitivity to thermal non-noxious and noxious stimuli without affecting the spinal inflammatory response associated to sciatic nerve injury and reduced morphine antinociception in the tail immersion test. Our findings propose GPR3 receptors as a new molecular target in neuropathic pain therapy as well as a new component of a pro-opioid receptor system.
- [Show abstract] [Hide abstract]
ABSTRACT: Chronic pain syndromes are often treatment refractory and pose an enormous burden of suffering for the individual. Chronic pelvic pain (CPP) is generally defined as noncyclic pain of at least 6 months duration and severe enough to require medical care or cause disability. CPP has been estimated to have a prevalence of 15% among women of reproductive age. Women are at increased risk for both major depression and chronic pain syndromes such as CPP, and are more likely to report antecedent stressful events, have higher rates of physical and sexual abuse, and subsequently develop posttraumatic stress disorder. High rates of sexual and physical abuse and other trauma have been shown among women with CPP, including symptoms of dyspareunia (pain during intercourse), dysmenorrhea (pain during menstruation), and vulvar pain. A detailed and comprehensive evaluation of the patient with CPP should include a thorough gynecologic exam and a full mental health assessment. Treatment of CPP must include an integrated approach targeted at both the psychiatric comorbidity and pain symptoms. A multidisciplinary treatment team offers the best chance for success with CPP, and it is critical to suggest psychiatric treatment (psychopharmacology and/or psychotherapy) in addition to traditional medical and surgical approaches.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.